Allegedly Negligent Colonoscopy Causes Spleen Injury

This case involves a 58- year-old-man who underwent an elective colonoscopy in an outpatient facility. He was discharged home shortly after the procedure. While at home, he began to feel very ill and fainted in his kitchen. He was brought to the emergency room where a spleen laceration was identified. Embolization was initially attempted, however, his hemoglobin continued to drop and he became increasingly symptomatic. He was then taken to the operating room for an emergent splenectomy, where an excess of blood was found in his chest cavity.

Question(s) For Expert Witness

1. How frequently do you perform colonoscopies?

2. What steps should be taken to avoid injury to the spleen during a colonoscopy?

Expert Witness Response E-096088

I am an assistant professor of gastroenterology and the associate director of adult nutrition at a major university in Chicago. I perform colonoscopies regularly. Typically, Iatrogenic injury is a rare complication associated with colonoscopy. However, a colonoscopy is the most common cause of iatrogenic splenic injury (in comparison to other procedures or surgeries). The risk factors for splenic injury are both patient and operator dependent. Patient-dependent factors include pre-existing enlargement of the spleen, surgical adhesions, inflammatory bowel disease, and severe diverticular disease. Operator dependent factors include placing the patient on their back, excessive traction, over sedation, slide by advancement, and applying excessive external pressure. Despite these factors, it is still difficult to discern if the complication is unpredictable or directly related to technical factors given rarity of this complication. A review of the colonoscopy report is required to discern if the splenic injury was simply an unfortunate event or the result of technical errors.